Where There is No Doctor to Call

Millions of patients, some in critical condition, have been left to their own defences as the entire country is busy battling the Novel Coronavirus pandemic. The ongoing crisis has taken the lives of less than a dozen people in the last two months. The first case in India was confirmed in the last week of January. Yet, the gates of government hospitals have already virtually closed to all non-Covid-19 patients. Such patients cannot approach a private nursing home or clinic either, as those, too, have been closed due to the lockdown, indeed, a curfew. 

Not even a cycle rickshaw is available anywhere in most localities for the critically-ill patients to transfer themselves to where they can be cared for. It’s a lockdown in the truest sense when the sick cannot even be moved to a government hospital or healthcare centre. All of these bodies are completely pre-occupied with controlling the spread of the Novel Coronavirus.

To take stock of the situation in Bihar’s capital, Patna, where one 38-year-old recently died of Covid-19, I visited a private nursing home that is owned by a city-based nephrologist. I heard the manager of the healthcare centre tell a lady attendant to bring a patient to the nursing home only after 31 March. The patient he was referring to was obviously from outside the city, for the manager then asked the woman: ‘where are you staying?’, and the reply was: ‘At a relative’s place.’ 

A visit to another health hub, also owned by a doctor, a surgeon who also happens to be a former Janata Dal United Member of Parliament, revealed a similar story. There was no doctor present at the clinic, obviously because of the lockdown. When I inquired if the doctor is expected to come the next day, pat came the reply: “No, he would not.” A handful of patients are still admitted at the clinic, as they are convalescing from surgeries that they have undergone a few days back. 

With not a rickshaw in sight, how these patients will go home, especially if they belong to places outside Patna, nobody knows. In India, not everyone has four-wheelers. In fact, there are only 22 cars per 1,000 Indians; India’s global rank on this index in 2015 was 141, which means that it is comparable with Zambia, Cambodia, Laos and Vietnam in terms of car ownership. And for the bulk of the population—982 of 1,000 Indians—ambulance services are also inadequate. Besides, they have become too costly to afford in this hour of crisis.

Forget private nursing homes in Patna. Even the All-India Institute of Medical Sciences (AIIMS) Delhi, has temporarily shut down its Out-Patient Department (OPD) from 24 March onwards, which is the first port of call for all visiting sick people. This measure has been taken to avoid the spread of Covid-19. The scenario that is being created is as if nobody is falling sick with any disease other than those infected by the Novel Coronavirus bug. Be not surprised by reports that other hospitals are thinking of following the example of AIIMS, Delhi.

One aspect of this decision, to shut down a hospital’s OPD which caters to citizens from across the country is that even patients suspected of Covid-19 will not show up at the hospital. For this reason, doctors are questioning this step, for the closing of hospital gates means that Covid-19 infected will remain at home, and within their communities, where they will raise the chances of infecting others. 

Of course, patients have been advised to approach the Emergency Ward directly, but in practice it is really difficult for family members of a victim to ascertain what disease their ward is suffering from.

Covid-19 has exposed how seriously ill the entire healthcare system in the country is. Actually, it is surviving on ventilator. In Uttar Pradesh, the Nurses Association has gone on the warpath as it is protesting the alleged failure of Chief Minister Yogi Adityanath’s government in providing them with hazmat suits, sanitisation kits, protective masks, and even sanitisers. 

Saraswati, who works in the Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, and is the general secretary of the Association, has said that the nurses are being compelled to work in hellish conditions at their paltry salary—Rs 10,000 to 16,000 a month. Besides, the doctors and pharmacists have been provided with protective kits although it is the nurses who come closest to the patients, have to take care of them, and for the longest times. Most of these nurses, according to Saraswati, are contractual labours. 

The scenario in the Medical College Hospital in Darbhanga town of Bihar is no different. Here, it is the doctors who are protesting against the absence of safety kits, sanitisers and other equipment that would reduce their chances of being infected by those who either carry the virus or are already sick from it. 

The passengers who have arrieved from different parts of the country to the towns and cities of Bihar, Uttar Pradesh, Bengal and even Delhi have horrific tales to tell their families and friends. These people, mostly labourers, were forcibly evicted by the landlords in the places where they had been working. This happened the moment the panic over the epidemic broke out, and the commercial establishments and business came to a screeching halt across the country.

Even the train services were abruptly halted––though domestic flights were allowed to fly until the midnight of March 24 night. That meant that thousands of labours from South Indian states, Maharashtra, Gujarat and so on, were left stranded at various places. The trains they usually take, and hoped to board again, and the bus services, were suspended. Curfew and lockdown have made their goal of reaching home extremely difficult.

In many cases they had to walk miles to reach their villages. Take the case of Buxar in Bihar. The last train from Ernakulum in Kerala to Patna arrived on the morning of 24 March. In all, 361 passengers deboarded at Buxar from this train. They went through a medical check-up that took a long time before they were allowed to leave the station. But this hungry and thirsty lot were not provided any food or drinking water by the Railways or the Bihar government.

As if that was not enough, it is learnt that this train was terminated at Ara, some 70 km before Patna. The tragedy is that these folks, now returning to their homes, are not even being welcomed by their co-villagers. They suspect that they are carrying the Novel Coronavirus, though they have been medically examined at the railway station.

This being the situation in India right now, though the number of identified people with Coronavirus infections is just over 560—far fewer than in most other countries, whether or not they are of comparable size and population—the question is, what happens if Covid-19 acquires a truly pandemic form in India as well? Will it not make our fears of many more infections, and therefore, deaths come true? If this comes to pass it will, no doubt, add to the existing burden of diseases in the country. For example, it is a well-established fact that tuberculosis, cancer, diabetes, malaria and other illnesses, are the biggest killers of Indians. 

Now imagine a scenario where these diseases have to be tackled along with this pandemic. In fact, confronting this reality is what the public is shying away from right now. However, the fact that the healthcare system in India could simply not take on this challenge at all, will remain in people’s memories for long. 

The author is a freelance journalist. The views are personal.